TRial to Assess Implementation of New research in a primary care Setting (TRAINS): study protocol for a pragmatic cluster randomised controlled trial of an educational intervention to promote asthma prescription uptake in general practitioner practices

Background There is a marked increase in unscheduled care visits in school-aged children with asthma after returning to school in September. This is potentially associated with children not taking their asthma preventer medication during the school summer holidays. A cluster randomised controlled trial (PLEASANT) was undertaken with 1279 school-age children in 141 general practices (71 on intervention and 70 on control) in England and Wales. It found that a simple letter sent from the family doctor during the school holidays to a parent with a child with asthma, informing them of the importance of taking asthma preventer medication during the summer relatively increased prescriptions by 30% in August and reduced medical contacts in the period September to December. Also, it is estimated there was a cost-saving of £36.07 per patient over the year. We aim to conduct a randomised trial to assess if informing GP practices of an evidence-based intervention improves the implementation of that intervention. Methods/design The TRAINS study—TRial to Assess Implementation of New research in a primary care Setting—is a pragmatic cluster randomised implementation trial using routine data. A total of 1389 general practitioner (GP) practices in England will be included into the trial; 694 GP practices will be randomised to the intervention group and 695 control group of usual care. The Clinical Practice Research Datalink (CPRD) will send the intervention and obtain all data for the study, including prescription and primary care contacts data. The intervention will be sent in June 2021 by postal and email to the asthma lead and/or practice manager. The intervention is a letter to GPs informing them of the PLEASANT study findings with recommendations. It will come with an information leaflet about PLEASANT and a suggested reminder letter and SMS text template. Discussion The trial will assess if informing GP practices of the PLEASANT trial results will increase prescription uptake before the start of the school year. The hope is that the intervention will increase the implementation of PLEASANT work and then increase prescription uptake during the summer holiday prior to the start of school. Trial registration ClinicalTrials.gov ID: NCT05226091 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06864-y.

children with asthma after they returned to school in September. It is thought that this is partially due to children not taking their asthma preventer medication during the summer holidays.
Our study found that a simple reminder letter sent by GPs to parents and guardians of children with asthma, reminding them to take their asthma medication during the summer holidays has resulted in: If you would like more information about our asthma study or have any questions, please contact us at: We are recommending that asthma leads at GP surgeries across England send a reminder letter or SMS text . This is to remind the parents or guardians of all school-age children with asthma to take their asthma medication during the summer break. If you' Click to download the letter or download the SMS text template.
If you would like more information or have any questions about our asthma study, Julious SA, Horspool MJ, Davis S, Franklin M, Smithson WH, Norman P et al (2018). Open-label, cluster randomised controlled trial and economic evaluation of a brief letter from a GP on unscheduled medical contacts associated with the start of the school year: the PLEASANT trial. BMJ Open, 8(4), e017367. Information for asthma leads and practice managers in GP surgeries.

Supported Leaflet
probably already received a letter from us highlighting how we can help you to reduce peaks in asthma for your young patients this summer.
across England, who'd like to know more about the study behind our summer awareness campaign for your young patients with asthma. a simple reminder to the parents or guardians of your young patients with asthma can out more.
The summer holidays are a crucial time for children with asthma to take their preventer medication ahead of the return to school, yet it often gets forgotten. and there's an increase in medical help. This may be due to their contact with infections as they begin to mix with children in school at the start of the new school year.
• Our research shows compared to children without asthma.
• During the summer holidays, there's prescriptions for asthma medication that are collected.
We carried out a trial of 12,179 school-age children in 141 GP practices across England and Wales, chosen at random. Our study found that a simple reminder letter sent by the family GP to parents or guardians of children with asthma, asking them to make sure their child takes their preventer medication during the summer holidays, has resulted in: scharr/research/centres/ctru/pleasant in un sc he du led me dic al co nta cts aft er the ret urn to sc ho ol in the pe rio d Se pte mb er to De ce mb er.
pres crip tion upta ke in Aug ust by 30% .
of £36 per child .

Subject: This summer help manage asthma in your young patients
To the Practice Manager and Asthma Lead, I am writing to you with recommendations that will help you and your GP practice to reduce serious, asthma-related exacerbations in your young patients with asthma, ahead of the return to school. (Please READ the attached letter) With one simple reminder message this summer, you and your GP surgery can enable your young patients to manage their asthma better.
Here's why: • The return to school in September is a time when asthma gets worse for children and there's an increase in medical help. • During the summer holidays, there's a significant drop in the number of prescriptions for asthma medication that are collected. • The summer holidays are a crucial time for children with asthma to take their preventer medication ahead of the return to school, yet often it gets forgotten.

How can we help you?
We are recommending that asthma leads like you at GP surgeries across England send a simple reminder letter or SMS text in July. This is to remind the parents or guardians of all school-age children with asthma to take their asthma medication during the summer break.
We've attached a sample reminder letter and SMS text (see attached). Alternatively click to download the letter or download the SMS text template.
With your help, this simple reminder to the parents of your young patients with asthma can significantly reduce the number of serious medical attendances, hospital admissions and the associated costs. Our recent University of Sheffield study (PLEASANT) of young patients with asthma supports this. You can find out more by reading the attached leaflet or visiting: https://www.sheffield.ac.uk/scharr/research/centres/ctru/pleasant

Who can you contact about our asthma study?
If you would like more information about our asthma study or have any questions, please contact us at: rahalyami1@sheffield.ac.uk